肺保护性通气加重呼吸机诱导的膈肌萎缩和无力  

Lung-protective ventilation exacerbates ventilator-induced diaphragmatic atrophy and weakness

作　　者：王飞[1] 周贤龙[2] 许天骄 曾容 WANG Fei;ZHOU Xianlong;XU Tianjiao;ZENG Rong(Wuhan Emergency Center,Wuhan Hubei 430022,China)

机构地区：[1]武汉市急救中心,湖北武汉430022 [2]武汉大学中南医院急救中心,湖北武汉430071

出　　处：《中国急救复苏与灾害医学杂志》2024年第4期514-517,529,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：武汉市卫健委科研项目(编号:WX20Z10)。

摘　　要：目的 肺保护性通气(LPV)可将呼吸机引起的肺损伤(VILI)的风险降至最低。然而,LPV是否能够减轻呼吸机引起的膈肌功能障碍(VIDD)目前尚不清楚。本研究旨在探索LPV能否保护膈肌避免发生VIDD。方法 成年雄性Wistar大鼠进行常规机械通气[潮气量(V_(T)):10 mL/kg,呼气末正压(PEEP):2 cmH_(2)O;CV组]或肺保护性通气(V_(T):5 mL/kg,PEEP:10 cmH_(2)O;LPV组)12 h。然后,收集膈肌和肺组织进行生化和组织学分析。结果 笔者的研究结果表明,与常规机械通气组相比,肺保护通气减轻了大鼠的肺损伤,并降低了肺组织氧化应激水平。然而,与常规机械通气组相比,肺保护通气组的大鼠的膈肌蛋白水解水平增加,肌纤维横萎缩,膈肌肌力降低。此外,肺保护通气组在膈肌中的氧化应激水平高于常规机械通气组(P<0.05)。结论 与常规机械通气相比,肺保护通气不能缓解大鼠膈肌发生VIDD。相比之下,肺保护通气可能通过诱导氧化应激使VIDD恶化。因此,找到一个合适的通气方式来同时保护肺和膈肌仍是具有挑战性和紧迫性的临床问题。Objective Lung protective ventilation(LPV)minimises the risk of ventilator-induced lung injury(VILI).However,whether LPV can alleviate ventilator-induced diaphragm dysfunction(VIDD)remains unknown.The aim of this study was to investigate whether LPV can protect the diaphragm from VIDD.Methods Adult male Wistar rats were subjected to conventional mechanical ventilation(tidal volume(V_(T) 10 mL/kg,positive end-expiratory pressure(PEEP):2 cmH_(2)O;CV group)or lung-protective ventilation(V_(T):5 mL/kg,PEEP:10 cmH_(2)O;LPV group)for 12-hour.Diaphragm and lung tissues werecollected for biochemical and histological analysis.Results Our results showed that LPV reduced lung injury and reduced the level of oxidative stress in lung tissue compared with CV.Rats in the LPV group had increased levels of diaphragm proteolysis,transverse muscle fiber atrophy,and decreased diaphragm muscle strength as compared with the CV group.In addition,the level of oxidative stress in the diaphragm was higher in the LPV group than that of the CV group(P<0.05).Conclusion Compared with rats in the CV,LPV cannot alleviate VIDD in rats.In contrast,the LPV may worsen VIDD by inducing oxidative stress in our study.

关 键 词：肺保护性通气 机械通气 膈肌功能障碍 氧化应激 

分 类 号：R3[医药卫生—基础医学]